Care pathways models and clinical outcomes in disorders of consciousness

Objective: Patients with Disorders of consciousness, are persons with extremely low functioning levels and represent a challenge for health care systems due to their high needs of facilitating environmental factors. Despite a common Italian health care path-way for these patients, no studies have analyzed information on how each region have implemented it in its welfare system correlating data with patients’ clinical outcomes. Materials and Methods: A multicenter observational pilot study was realized. Clinicians collected data on the care pathways of patients with Disorder of consciousness by ask-ing 90 patients’ caregivers to complete an ad hoc questionnaire through a structured phone interview. Questionnaire consisted of three sections: sociodemographic data, description of the care pathway done by the patient, and caregiver evaluation of health services and information received.Results: Seventy- three patients were analyzed. Length of hospital stay was different across the health care models and it was associated with improvement in clinical diag-nosis. In long- term care units, the diagnosis at admission and the number of caregivers available for each patient (median value=3) showed an indirect relationship with worsening probability in clinical outcome. Caregivers reported that communication with professionals (42%) and the answer to the need of information were the most critical points in the acute phase, whereas presence of Non- Governmental Organizations (25%) and availability of psychologists for caregivers (21%) were often missing during long-term care. The 65% of caregivers reported they did not know the UN Convention on the Rights of Persons with Disabilities. Conclusion: This study highlights relevant differences in analyzed models, despite a recommended national pathway of care. Future public health considerations and ac-tions are needed to guarantee equity and standardization of the care process in all European countries

Structure-activity relationship of the exopolysaccharide from a psychrophilic bacterium: A strategy for cryoprotection

Microrganisms from sea ice, glacial and subglacial environments are currently under investigation due to their relevant ecological functions in these habitats, and to their potential biotechnological applications. The cold-adapted Colwellia psychrerythraea 34H produces extracellular polysaccharides with cryoprotection activity. We here describe the purification and detailed molecular primary and secondary structure of the exopolysaccharide (EPS) secreted by C. psychrerythraea 34H cells grown at 4 °C. The structure was determined by chemical analysis and NMR. The trisaccharide repeating unit of the EPS is constituted by a N-acetyl quinovosamine unit and two residues of galacturonic acid both decorated with alanine. In addition, the EPS was tested in vitro showing a significant inhibitory effect on ice recrystallization. In-depth NMR and computational analysis suggest a pseudohelicoidal structure which seems to prevent the local tetrahedral order of the water molecules in the first hydration shell, and could be responsible of the inhibition of ice recrystallization. As cell cryopreservation is an essential tool in modern biotechnology and medicine, the observations reported in this paper could pave the way for a biotechnological application of Colwellia EPS

Économies de la pauvreté au Moyen Âge

International audienceCet ouvrage collectif issu des réflexions d’un groupe de travail rassemblant des chercheurs principalement français, espagnols, italiens. S’efforçant de dépasser les problématiques étudiées dans les années 1960-1980, autour de M. Mollat, il propose une réflexion renouvelée autour du thème de la pauvreté au Moyen Âge afin de saisir les phénomènes économiques et sociaux la caractérisant : les processus d’appauvrissement, la pauvreté laborieuse, les attitudes institutionnelles et personnelles face à la pauvreté, la culture matérielle liée à la pauvreté forment le sujet de l’ouvrage. Or, ses rapports avec le travail, avec les liens noués ou dénoués à l’intérieur des groupes sociaux ainsi que les stratégies de survie sont tout aussi fondamentales

Patterns of care and economic consequences of using bone-targeted agents for castration-sensitive prostate cancer patients with bone metastases to prevent skeletal-related events in Switzerland - the SAKK 95/16 prostate study

International guidelines state that bone-targeted agents such as denosumab or zoledronic acid at doses used for bone metastasis are not indicated for patients with metastatic castration-sensitive prostate cancer (mCSPC) with bone metastases. Whereas denosumab has never been studied in this patient population, zoledronic acid has been shown to be ineffective in decreasing the risk for skeletal-related events. This study estimates the prevalence and economic consequences of real-world use of bone-targeted agents for mCSPC patients in Switzerland.; To estimate the frequency of bone-targeted agent administration and skeletal-related events, data from a non-interventional, cross-sectional survey involving oncologists across Switzerland (SAKK 95/16) was combined with data from the Swiss National Institute for Cancer Epidemiology and Registration (NICER). Economic parameters were calculated from the perspective of the healthcare system over the median time to prostate-specific antigen (PSA) progression for the extrapolated patient group, using data from NICER. The cost calculation covered costs for bone-targeted agents, their administration and skeletal-related events. The time to PSA progression (33.2 months), as well as the probability and cost of skeletal-related events were derived from the literature.; The survey was answered by 86 physicians treating 417 patients, of whom 106 (25.4%) had prostate cancer, with 36 (34.0%) of these mCSPC. The majority of mCSPC patients (52.8%, n = 19) received bone-targeted agents monthly. Denosumab was the treatment of choice in 84.2% of patients (n = 16). Extrapolation using data from NICER indicated that 568 mCSPC patients may be treated with bone-targeted agents at doses used for bone metastasis every year in Switzerland, leading to estimated total costs of more than CHF 8.3 million over 33.2 months. Because of its more frequent prescription and higher price, it appears that almost 93% of the total costs can be attributed to denosumab. For both denosumab and zoledronic acid, the most expensive components were the cost of administration and the drug cost, making up more than 90% of the total costs, with the rest being costs of skeletal-related events.; This study found that the administration of bone-targeted agents in doses used for bone-metastatic diseases to prevent skeletal-related events is frequent in the setting of mCSPC and results in significant costs for the healthcare system

Calculs et rationalités dans la seigneurie médiévale

Dans le cadre d'une réflexion collective animée par le Lamop (UMR 8589) sur la circulation des richesses au Moyen Âge, cet ouvrage de référence définit certains des critères guidant la prise de décision des seigneurs en matière de politique économique. Il démontre que, loin d'être des surconsommateurs parasites, les seigneurs sont des agents économiques susceptibles de prendre des décisions informées, conscients en tout cas de leurs revenus et de l'évolution de ceux-ci. Partant de l'analyse des revenus tirés du travail paysan ainsi que de la structure du prélèvement opéré sur les terres, les auteurs de l'ouvrage établissent les normes du comportement seigneurial à travers une enquête portant sur toute l'Europe occidentale. Au cœur du questionnement se trouve toujours la question de la conversion – c'est-à-dire du moment où les gestionnaires changent de mode de prélèvement – et de ses modalités. Il s'agit d'abord d'une opération technique et c'est ainsi qu'elle est ici envisagée sous les différents aspects qu'il a été possible de retrouver. Les revenus seigneuriaux ne sont pas un donné stable et leur structure, en argent ou en nature, est susceptible d'évoluer. Face aux événements économiques perceptibles comme l'inflation monétaire et la hausse des prix, ou encore l'augmentation de la demande urbaine, les seigneurs réagissent. Des choix sont faits, des décisions sont prises qui touchent à l'organisation même du prélèvement seigneurial. Derrière les transformations décidées dès le xiie siècle par des acteurs individuels se lit le rapport des seigneurs au marché et à l'économie d'échange, qui s'avère extrêmement complexe. Les études de cas proposées les montrent aptes à tirer le meilleur parti possible de leur allocation de ressources, sans préjudice bien sûr des autres déterminants de leur action puisqu'ils demeurent contraints par un code complexe qui leur permet tout à la fois d'assurer et de renforcer leur domination sur le monde paysan et de construire leur prestige, leur pouvoir et leur honneur. La seigneurie est un organisme vivant dont les gestionnaires savent calculer, parfois dans le long terme, et prendre des décisions dont les motivations sont aussi de nature économique.Ouvrage publié avec le concours du Conseil scientifique de l'université Paris 1 et de l'UMR 8589-CNRS (Laboratoire de médiévistique occidentale de Paris

Petrifying Wealth

Sitio web del proyecto “Petrifying Wealth. The Southern European Shift to Collective Investment in Masonry as Identity , c.1050-1300”..-- Propósito: científico.-- Fecha de la consulta: 2019-05-24. Se incluye enlace al vídeo: 'Petrifying Wealth' explicado por su coordinadora, Ana Rodríguez.Between the years 1050 and 1300 the European landscape turned to stone. It was a structural transformation that led to the birth of a new, long-lasting panorama and helped in the creation of individual, collective and regional identities: a landscape epitomising the way we see the space and territory of Europe. The project Petrifying Wealth seeks to rewrite the social history of the central Middle Ages, emphasizing the need to reassess from an untried perspective an element that has always been present in our vision of the period—the sudden ubiquity of masonry construction—but which has hardly been given the opportunity to provide in-depth explanations for complex social dynamics. A project that seeks to offer novel explanations to previously unasked questions about wealth, building, and collective identity. The speed, extent, and systematization of the construction of churches, towers, castle walls, palaces, and houses within castles and cities provide evidence of an underlying, if unaddressed, issue. That is, it is precisely in the twelfth and thirteenth centuries that the structural link can most clearly be seen between both private and collective wealth, and the investment in stone structures built to last. The study of the shift involving new institutional dynamics, but also unprecedented social practices, as well as ideological concepts radically different from those that had prevailed until then, aims to break down assumptions that have naturalized this truly astonishing process while using as case studies the undervalued regions of southern Europe to explore the larger questions. By inverting the standard approach that sees the heart of the former Carolingian empire (present-day France and Germany) as the wellspring from which other “peripheral” territories drank, Dr. Ana Rodríguez (CSIC, Spain) and Dr. Sandro Carocci (Università di Roma Tor Vergata, Italy) will undertake to bring new light to probe the greater meaning behind the process of masonry building as an investment in social identity in the central Middle Ages.Peer reviewe

Analysis of Italian regulations on pathways of care for patients in a vegetative or minimally conscious state

Different rehabilitation models for persons diagnosed with disorders of consciousness have been proposed in Europe during the last decade. In Italy, the Ministry of Health has defined a national healthcare model, although, to date, there is a lack of information on how this has been implemented at regional level. The INCARICO project collected information on different regional regulations, analysing ethical aspects and mapping care facilities (numbers of beds and medical units) in eleven regional territories. The researchers found a total of 106 laws; differences emerged both between regions and versus the national model, showing that patients with the same diagnosis may follow different pathways of care. An ongoing cultural shift from a treatment-oriented medical approach towards a care-oriented integrated biopsychosocial approach was found in all the welfare and healthcare systems analysed. Future studies are needed to explore the relationship between healthcare systems and the quality of services provided

Écritures de l’espace social

L'histoire sociale du Moyen Âge est aujourd'hui en pleine évolution : elle redéfinit ses objets et, construisant des approches originales, délaisse vieux paradigmes et anciennes périodisations, sans rien renier pour autant de l'acquis transmis par les générations précédentes. Ce livre s'empare des thématiques les plus renouvelées depuis les années 1990 - l'espace, l'écriture, la vie économique comprise comme l'une des modalités de la domination sociale. Ces différentes approches témoignent du dynamisme d'une discipline qui se place délibérément à la croisée des sciences de l'homme et de celles de la société, n'hésitant pas, pour enrichir ses analyses, à mobiliser les concepts de la sociologie et de l'économie. Des sciences plus classiques et plus techniques, comme la paléographie et la diplomatique, sont de la même façon convoquées pour saisir les raisons de l'inscription des choses et des faits dans des listes ou dans des récits. Au cœur de ces problématiques se retrouvent les notions de territoire, seigneurie, paroisse mais également des sujets qui rénovent l'histoire sociale, telle l'anthroponymie. L'histoire économique, quant à elle, dépassant les débats qui ont structuré son historiographie dans la seconde moitié du XXe siècle, cherche à définir les notions-clés de crise ou de commercialisation et s'interroge sur le fonctionnement concret de la société paysanne. Conçu comme un hommage à Monique Bourin et à son œuvre d'historienne, ce livre atteste de la richesse et de la fécondité de son enseignement ainsi que de son talent à transformer un champ d'études en guidant et fédérant les travaux de très nombreux chercheurs